Planning grant for clinical trial of implicit bias mitigation training for clinicians

Hypertension is a leading cardiovascular disease risk factor in the US and a leading cause of stroke, kidney disease, and heart failure. Compared to White individuals, it is more prevalent, severe, and uncontrolled in Black individuals, who have almost two-fold higher age-adjusted mortality for hypertension-related

cardiovascular deaths. Clinician implicit bias (IB) contributes to health disparities, including hypertension disparities. Because hypertension is most often treated by primary care clinicians, this group is a high priority for intervention to mitigate IB. Therefore, in order to achieve cardiovascular health equity, it is crucial to

mitigate the impact of primary care clinician IB in hypertension care. We have developed and pilot-tested an evidence-based curriculum (“Reaching Equity”) designed to teach practicing clinicians IB mitigation skills. Preliminary data in a group of non-primary care clinicians indicated that clinicians are motivated to address IB in health care, that Reaching Equity is feasible and acceptable, and that

clinician confidence in providing equitable care increased. In order to proceed to a definitive clinical trial to test the hypothesis that Reaching Equity will increase use of IB mitigation skills by primary care clinicians and reduce racial disparities in hypertension outcomes, further work is needed and will be accomplished in the proposed project. We will refine and standardize the Reaching

Equity curriculum, and additionally develop and standardize protocols for a) clinician enrollment and engagement; b) patient enrollment and engagement; c) implementation of patient-initiated audio-recording of clinical encounters; d) analysis of recorded encounters; e) extraction of blood pressure and other data from the

EHR; and f) data management and analysis. We will pilot these protocols in two primary care clinics, enrolling 20 primary care clinicians and 100 patients. Outcomes will include an objective measure of IB mitigation skills immediately after completing intervention and EHR-generated assessment of hypertension control 3 and 6

months after intervention. In addition, we will obtain qualitative feedback from clinicians on study procedures, curriculum content/format, and ways to sustain learning. The proposed work is necessary and sufficient for the conduct of a subsequent full-scale randomized trial to test the hypothesis that Reaching Equity will increase use of implicit bias mitigation skills by clinicians and

reduce racial disparities in hypertension outcomes.